Cosmetic Surgery Excellence

Botox Q & A #4 – Realself

Q: Botox for Brow Ptosis?

I’m thinking of getting botox for my brow ptosis as I’m starting to get horizontal lines in my forehead and almost daily headaches to the front of my head from keeping my eyebrows lifted (otherwise the droop bothers me and feels heavy on my eyes). I’ve been trying to do some research as to whether this is a good alternate to surgery since it’s not all that bad yet and am finding conflicting answers. My main concern is that the botox will make it worse. Can anyone help clear this up?

A: Botox is wonderful for wrinkles, but as you suspect may well reveal other underlying problems

The “brow lift” with Botox is used to elevate the lateral brow slightly.  Injection may well make your ptosis of the brow or even excessive upper eyelid skin look worse.  Looking at the picture attached to your question, it appears as though your lateral brow is nicely positioned above the lateral orbital rim. The medial brow is at the margin of the orbital rim.  This alignment is very aesthetic and is actually the ideal.

There are several issues in your question.  The 1st is the head aches.  These are wonderfully & usually immediately halted with the use of the Botox/Dysport injection.  This will effectively smooth the forehead & wrinkles between the brows above and on the nose.  The injection of these paralytics is effective when infiltrating under the lateral brow to induce some lift of the lateral brow, as well.

Your picture shows a beautiful arch and adequate lateral elevation of the lateral brow.  The Dysport/Botox will not raise the medial brow, and injection into this area will undoubtably result in more ptosis.  The heaviness of the eyes and the need to actively raise the brows is most likely related to the very short orbit which leaves little space for the excess upper eyelid skin that develops with aging.

It would be great to see you in person to be sure, but it sounds like the shallow orbit is making the excessive upper eyelid skin which feels very heavy on the eye and thus you lift your brows to “see’ better. If this is the case, my recommendations would be to consider the upper eyelid blepharoplasty to remove the excess skin.  This results in a barely visible scar, alleviates the weight of the eyelid and reduces the need to elevate the brow subconsciously and volitionally.

I recommend Dysport/Botox to the forehead & between the brows medially & between to alleviate the tension, relieve you of the headaches, and to eliminate the wrinkles.  I would caution you away from considering a surgical brow lift as they often create an unusual brow shape and your brows are very aesthetic and well balanced.

Good luck!

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